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The definition of “complex patients” is changing and so is the way they are being cared for. Providers are now regularly treating patients who, not long ago, would have succumbed to their illnesses at earlier ages or lived with debilitating impairments. Often thought of as “outliers,” the number of patients who are considered complex or high-risk is increasing due to changes in demographics and innovations in treatment and technology.

The purpose of ECRI Institute’s 21st Annual Conference on the Use of Evidence in Policy and Practice is to take status on how America’s healthcare system is changing to care for complex patients, how this care is being financed, and how and where this care takes place. ​

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ECRI Institute's 21st annual conference sessions are available on YouTube.

Thursday, November 6, 2014

7:00 ​

Registration and Continental Breakfast

​8:00 

​Welcome, Acknowledgements, and Introduction to the Format and Major Themes of the Conference

8:20

Session 1: Complex Patients, Health Systems, and the Continuity of Care

This session introduces some of the major challenges of the conference’s theme from a patient-centered perspective. “Complex patient” can mean different things, among them, frequently admitted and readmitted patients who are fragile, including newborns, or those who have lived long enough to become frail; those with multiple chronic conditions; and those who have benefitted or may benefit from newer and perhaps riskier – often costlier – treatments and technology. This session will examine how the healthcare system looks from the point of view of the complex patient, focusing on patient-centered research and policy making. It examines whether and how these perspectives are being brought together.

Upon completion of this session, participants will be able to:

  • Define what the “new” complex patient is

  • Examine the major challenges of treating the “new” complex patient from a patient-centered perspective

  • Survey the ethical considerations involved in providing truly patient-centered care

  • Debate whether and how the perspectives of patients and the healthcare system are being brought together

  • Examine how the healthcare system looks from the point of view of the complex patient, focusing on patient-centered research and policy making

Watch video to learn more about this session

  • David Atkins, MD, MPH, Director of Health Services Research & Development, U.S. Department of Veterans Affairs bio

  • Amy L. Kratchman, Family Consultant; Director, Leadership Education in Neurodevelopmental Disabilities Family Collaboration, The Children’s Hospital of Philadelphia; Member, Advisory Panel on Patient Engagement, PCORI presentation

  • Mary Elizabeth Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Professor of Epidemiology (Chronic Diseases) and of Investigative Medicine; Section Chief, Geriatrics, Yale School of Public Health bio l presentation

  • Moderator: Joe V. Selby, MD, Executive Director, Patient Centered Outcomes Research Institute (PCORI) bio

​9:20

Q&A

9:40

Break

​10:00

Session 2: The Clinical Perspectives on Complex Patients

Providers are now regularly treating patients who, not long ago, would have succumbed to their illnesses at earlier ages or led more impaired lives. This new type of “complex patient” is posing a challenge across the continuum of patient care. This session will look at how providers are defining today’s complex patients. This session will also address how providers are adapting their delivery of care to meet the needs of these patients. It will examine whether there are care models that are improving outcomes for complex patients.

Upon completion of this session, participants will be able to:

  • Examine how the “new” complex patient is posing a challenge across the continuum of patient care

  • Assess the ethical issues that arise in the treatment of complex patients

  • Describe how providers are defining today’s complex patients

  • Survey how providers are adapting their delivery of care to meet the needs of these patients

  • Identify care models that are improving outcomes for complex patients

Watch video to learn more about this session

  • Valerie Garrett, MD, Medical Director, Diabetes Center, Mission Health bio l presentation

  • Uma R. Kotagal, MBBS, MSc, Senior Vice President, Quality, Safety and Transformation; Executive Director, James M. Anderson Center for Health Systems Excellence, Professor, UC Department of Pediatrics, Cincinnati Children’s Hospital Medical Center bio l presentation

  • David O. Meltzer, MD, PhD, Chief of the Section of Hospital Medicine, Director of the Center for Health and the Social Sciences, and Chair of the Committee on Clinical and Translational Science, Associate Professor, Department of Medicine, The University of Chicago bio l presentation

  • Moderator: Bernadette Loftus, MD, Associate Executive Director, The Permanente Medical Group

11:00

Q&A

11:20

Session 3: In and Out of Hospitals: Federal and State Initiatives

Healthcare delivery models are rarely designed specifically for complex patients. But, many new state programs and federal pilot projects are designed with “Complex Patients” in mind, such as Medicare-Medicaid enrollee models. Care delivery and payment models, like Accountable Care Organizations (ACOs), Health Homes, Patient Centered Medical Homes (PCMHs), Center for Medicare & Medicaid Innovation (CMMI) Grants, and bundled payments, are aimed at promoting a high-performing, cost-effective healthcare system under the Affordable Care Act. These new care delivery models have also been identified as a vehicle for providing mental health and substance abuse care to patients, lessening dependence on behavioral health settings. This session will discuss whether these initiatives are serving complex patients adequately.

Upon completion of this session, participants will be able to:

  • Survey several state programs and federal pilot projects designed to treat the “new” complex patients

  • Examine how these state and federal programs are addressing mental health and substance abuse

  • Debate whether these initiatives are serving complex patients adequately

Watch video to learn more about this session

  • Melanie Bella, Director, Medicare-Medicaid Coordination Office, Centers for Medicare and Medicaid Services bio

  • Patrick Conway, MD, MSc, Chief Medical Officer, Center for Medicare and Medicaid Services; Director, Center for Clinical Standards and Quality bio l presentation

  • Marcia P. Reissig, RN, MS, Chief Executive Officer, Sutter Care at Home bio l presentation

  • Joseph W. Thompson, MD, MPH, Surgeon General, State of Arkansas, Director, Arkansas Center for Health Improvement, Pediatrician and Professor, University of Arkansas for Medical Sciences presentation

  • Moderator: Alan Weil, JD, Editor-in-Chief, Health Affairs bio

12:40

Q&A

​1:00

Lunch Provided in Great Hall

2:00

Session 4: The Triage Role of Emergency Departments: Has the “Spoke” Become a “Hub”?

Emergency departments have, for many years, played multiple roles – providers of emergency care, acute care, mental health care, diagnostic testing, and, very often, of primary care to economically disadvantaged and uninsured patients. With the Medicaid expansion under the Affordable Care Act, it was believed that the newly insured would begin to rely less on emergency rooms because of increased access to primary care. However, today, there are more visits to emergency departments than ever before. This session will address whether and how emergency departments are becoming an even more important component of integrated healthcare delivery systems.

Upon completion of this session, participants will be able to: 

  • Examine the changing role of emergency departments

  • Assess whether and how emergency departments are becoming an even more important component of integrated healthcare delivery systems

Watch video to learn more about this session

  • Richard W. Grant, MD, MPH, Research Scientist; Director, Delivery Science Fellowship, Division of Research, Kaiser Permanente bio l presentation

  • Arthur L. Kellermann, MD, MPH, ‎Dean, Hébert School of Medicine, Uniformed Services University of the Health Sciences bio l presentation

  • Alexander M. Rosenau, DO, FACEP, President, American College of Emergency Physicians; Senior Vice Chair, Department of Emergency Medicine at Lehigh Valley Health Network bio l presentation

  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

3:00

Q&A

3:20

​Break

3:40

Session 5: Does Technology Keep Patients Out of Hospitals?

Providers and payers are employing sophisticated technologies in the forms of Electronic Health Records (EHRs), Patient Health Records (PHRs), telemedicine, and sophisticated drugs and medical devices to improve patient outcomes. How they impact provider workflow is a key concern, as are the errors they may introduce. This session will examine the potential and known benefits and harms of some of these technologies and whether they truly facilitate keeping patients out of hospitals.

Upon completion of this session, participants will be able to:

  • Assess the impact new technologies have on provider workflow

  • Debate how to address errors associated with these new technologies

  • Identify potential and known benefits and harms of some of these technologies

  • Examine whether new technologies truly facilitate keeping patients out of hospitals

Watch video to learn more about this session

  • Stephen T. Lawless, MD, MBA, Vice President of Quality and Safety, Nemours, Alfred I. duPont Hospital for Children bio l presentation

  • Lee H. Schwamm, MD, FAHA, Executive Vice Chairman, Department of Neurology, C. Miller Fisher Endowed Chair & Director, MGH Stroke Services, Co-Director, Institute for Heart, Vascular & Stroke Care, Massachusetts General Hospital, Professor of Neurology, Harvard Medical School bio l presentation

  • Jeffrey E. Shuren, MD, JD, Director, Center for Devices and Radiological Health, the Food & Drug Administration bio l presentation

  • Moderator: Murray N. Ross, PhD, Vice President and Director, Institute for Health Policy, Kaiser Permanente bio

4:40

Q&A

5:00 ​

Day 1 Wrap Up Remarks

​Friday, November 7, 2014

​7:00  

​Registration and Continental Breakfast

​8:00

Opening of Day 2 Remarks

8:05

Session 6: Care Outside the Hospital: Maintaining Quality and Safety

​Most patients receive the majority of their care from multiple providers in a variety of care settings. Ensuring the quality and safety of healthcare outside the traditional institutional settings produces additional challenges. These are compounded when the patients are complex or high risk. The complexity can be an intricate blend of mental and physical health issues. Can the lessons learned from patient safety and quality research on inpatient care be applied to the other types of care settings, or has a new approach been developed?

Upon completion of this session, participants will be able to:

  • Survey how the “new” complex patient is receiving care “in and out” of the hospital

  • Debate whether lessons learned from patient safety and quality research on inpatient care be applied to the other types of care settings

  • Examine whether a new approach to caring for complex patients has been developed and if it is working

Watch video to learn more about this session

  • Stephan D. Fihn, MD, MPH, Director, Office of Analytics and Business Intelligence, VA Puget Sound Health Care System bio l presentation

  • Gordon Schiff, MD, Associate Director, Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Associate Professor of Medicine, Harvard Medical School presentation

  • Ronni P. Solomon, JD, Executive Vice President and General Counsel, ECRI Institute presentation

  • Moderator: Janet Corrigan, PhD, ‎Distinguished Fellow, the Dartmouth Institute for Health Policy and Clinical Practice 

9:05 ​

Q&A

​9:25

Session 7: The Private Payer Perspective on Complex Patients

This session will be a discussion among private payers on their policy and business initiatives designed for addressing coverage of complex patients in and out of hospitals. This includes how they address with providers and customers the expenses and access to care associated with complex patients, including how they are using data to “hot spot” and identify high--risk patients. The discussion will include the interface and inter-digitation between the public and private sectors. It aims to elicit the thinking behind, as well as status of, current approaches.

Upon completion of this session, participants will be able to:

  • Examine the policy and business initiatives of private payers designed for addressing coverage of complex patients in and out of hospitals

  • Identify how private payers address with providers and customers the expenses and access to care associated with complex patients

  • Discuss the concept of “hot spotting” and the ethical implications associated with that process

  • Examine the interface and inter-digitation between the public and private sectors

  • Identify the status of new initiatives that address the “new” complex patient

Watch video to learn more about this session

  • Andrew Baskin, MD, National Medical Director for Quality Performance, Aetna bio l presentation

  • Sam Nussbaum, MD, Executive Vice President, Clinical Health Policy and Chief Medical Officer, WellPoint presentation

  • Gail Wilensky, PhD, John M. Olin Senior Fellow, Project HOPE bio

  • Moderator: Carmella A. Bocchino, RN, MBA, Executive Vice President, Clinical Affairs and Strategic Planning, America’s Health Insurance Plans

​10:25

Q&A

​10:45

Break

​11:05

Session 8: Health Delivery System Executives: The Financial and Organizational Strategies of Caring for Complex Patients

Senior healthcare delivery system executives must sort and merge evidence of clinical effectiveness in the care of complex patients with cost considerations and an extremely wide range of intricate, applied, organizational issues. Complicating this decision-making process is health systems’ obligation to fulfill community care and benefit requirements. This session is a discussion among CEOs who integrate research into their management. It aims to elicit their thinking and current approaches. The audience Q&A will be integrated into the session.

Upon completion of this session, participants will be able to:

  • Identify the challenges faced by healthcare delivery system executives in providing treatment to the “new” complex patient

  • Examine how health systems are fulfilling their community care and benefit requirements

  • Discuss how executives are incorporating research into their decision-making process and what type of evidence they are using

Watch video to learn more about this session

  • Benjamin K. Chu, MD, MPH, MACP, Regional President, Kaiser Permanente Southern California

  • Elizabeth B. Concordia, President and Chief Executive Officer, University of Colorado Health

  • Moderator: Ralph Muller, President and Chief Executive Officer, University of Pennsylvania Health System

​12:15

Session 9: Capstone Session
This session unites issues and perspectives from the previous sessions and adds fresh perspectives on how to address the needs of complex patients.

Upon completion of this session, participants will be able to:

  • Identify new areas for research related to treating the “new” complex patient

  • Describe what is on the “horizon” for the treatment of the “new” complex patient

Watch video to learn more about this session

  • Janet M. Marchibroda, Director, Health Innovation Initiative, Executive Director, CEO Council on Health and Innovation, Bipartisan Policy Center bio

  • Larry Norton, MD, Deputy Physician-in-Chief for Breast Cancer Programs; Medical Director, Evelyn H. Lauder Breast Center; Norna S. Sarofim Chair in Clinical Oncology, Memorial Sloan-Kettering Cancer Center bio

  • Lucy A. Savitz, PhD, MBA, Director of Research and Education, Institute for Health Care Delivery Research, Intermountain Healthcare; Research Professor, Clinical Epidemiology, Director, CTSA Patient Centered Research Methods Core, University of Utah bio

  • Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI, President, Clinical Services and Chief Medical Officer, HCA; Chair-Elect Designate, American Hospital Association bio

  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

​1:00

Networking Lunch Sponsored by Kaiser Permanente

​2:00

Conference Ends

 

The National Academy of Sciences
2101 Constitution Ave, NW
Washington, DC 20418